Last month, I wrote about dissonance that occurs, when I perceive discord among yoga teachers and other movement thinkers, whose work I follow. As a yoga teacher, former research librarian, soon to be Restorative Exercise Specialist™, and someone with rebellious tendencies, I am wired to ask a lot of questions about what is being taught in yoga – and why – and whether cues were informed by research or lineage. Often this results in mental compromises (and annoyed teachers & colleagues) as I try to reconcile such teachings with each other and with what I experience in my body or with my students and clients. There comes a time when a clarifying convergence of ideas emerges that confirms I am on the right path and following teachings from which I am meant to learn. This is one of those occasions.
In previous posts (listed below), I discussed plantar fasciitis (aka plantar fasciosis) and biomechanical and environmental factors that can be addressed conservatively through yogasana, plantar fascia-specific stretching, alignment, and conditioning.
Previous posts on plantar fasciitis and exercises that can help:
Upon returning yesterday from what has come to be known as the Jules Mitchell Portland Tour, I found the September 1, 2015 issue of my partner’s American Family Physician peer-reviewed journal sitting on my desk with a section circled. The article was titled “Top 20 Research Studies of 2014 for Primary Care Physicians.” Basically, a group of clinicians with expertise in evidenced-based medicine performed monthly surveillance on 110 clinical research journals in 2014 (the 20th year they have been doing such surveillance). They identified 255 studies that had potential to change how family physicians practice, and narrowed that group down to 20 studies with relevance to primary care practice, validity, and likelihood that they could change practice. The section circled for my benefit was from one of these 20 studies titled “High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up,” which addressed the question of whether strength training is more effective than stretching for patients with plantar fasciitis. The bottom line answer was YES. “A regimen of strength training improves pain and function in patients with plantar fasciitis faster than a typical stretching regimen. Over time, though, patients who stretch will continue to improve and have similar improvement.” My take home, after reading the full study, is that high-load strength training, at 3 months out, resulted in quicker reduction in pain and improvement in function, when compared to stretching alone. However, 3 months was the magic time period. Before three months and at 6 and 12 months, strength training was not superior to stretching.
So, how does this research study on plantar fasciitis converge with the Jules Mitchell Portland Tour? Jules is one of the teachers in my dissonance piece. She is a biomechanist and yogi, who wrote her masters thesis on the science of stretching and turned the world of yoga on its head. One of her workshops that I attended this weekend was an impressive attempt to distill 3 years of research on the biomechanics and neuromechanisms of stretching into 8 hours of yoga workshop. The piece that is relevant here, further distilled from 3 years of research to 8 hours of workshop to two minutes of interpretive writing, is that loading connective tissues, which happens in active static stretching and isometric and eccentric training, is how we get stronger, healthier connective tissues. It is all about the load. You must input load. It is so much more complicated and nuanced than that…I challenge you to learn more by reading Jules’ seminal post on tissue mechanics, which begins her blogging journey of her thesis work.
In explaining results of the plantar fascia study, the authors confirm Jules’ findings that large tensile forces (loads) are associated with improvements in symptoms in conditions involving degenerative changes, like plantar fasciosis. Since the plantar fascia is composed of type 1 collagen fibers, it responds to high loads by laying down more collagen, which may help improve the condition. An additional benefit of high-load strength training is increased ankle dorsiflexion strength, as decreased ankle dorsiflexion strength has previously been identified in those with plantar fasciosis.
Applied exercises in your home yoga practice
With a little creativity, you can use yoga props to combine ankle dorsiflexion and controlled loading of the plantar fascia. This exercise can be used by those with or without plantar fasciosis, as it trains active mobility and improves strength at end ranges of motion in your feet and ankles, which is good for everyone. We know that strong, flexible feet are healthy, happy, and mobile.
I use a block, half round, and yoga mat. You can use a stair step or low stool in place of a yoga block and a rolled up towel or yoga mat for the half round/mat combo in the images below.
The first two pictures show my naked set-up, but I actually cover the whole contraption with a yoga mat because the half-round slides on the block without the mat, when I start doing the exercise. You probably won’t get slippage if you are using a towel instead of a half-round.
- Place the toes of your right foot on the mat-wrapped half-round (towel), so that they are maximally dorsal flexed, meaning your toes extend back towards you.
- Place the ball of your foot on the block (stool or step).
- Hold onto a chair/rail for balance and slowly, over a period of 3 seconds, lift your right heel, so that you rise up onto the ball of your foot (concentric phase).
- Remain in the raised position for 2 seconds (isometric phase).
- Slowly lower your heel, over a period of 3 seconds, to slightly below the level of the block (eccentric phase). The rise, hold, & lower is one rep.
- Repeat up to 12 times (reps) for up to 3 sets.
- Once you can do 3 sets of 12 reps, play around with increasing the load by wearing a loaded backpack. You might decrease the number of reps at this new load, but increase the number of sets. The idea here is to progressively load the tissues as you get stronger.
- Perform this exercise every other day.
- If you find you are not strong enough to do unilateral heel raises, try using both feet at the same time until you are stronger.
- This protocol is just a suggestion. Modify the load, reps, sets, and props, customizing it to suit your strength, flexibility, and movement history.
P.S. Look at how in the first picture, both ankles are dorsal flexed; and in the second both are plantar flexed. Not intentional. Just a neural pathway, I guess.
Consider adding this exercise to your foot health protocol of stretching, strengthening, and mobilizing your feet.